Why does my gum hurt years after wisdom tooth removal?

wisdom tooth removal
After wisdom tooth removal, everything should be back to normal. Swelling and pain should gradually decrease, and your gums will return to their normal appearance within a few weeks.

If pain surpasses the expected duration, talk to your dentist, as it could be indicative of various oral or facial conditions. Occasionally, it may point to a postoperative complication.

This persisting ache may manifest as a constant sensation lasting weeks or months, or it might periodically resurface with recurring symptoms over the years.

The underlying mechanisms and causes of pain that appear years after wisdom teeth extraction

Pain that lasts or suddenly appears years after a wisdom tooth extraction can have different meanings.

It is not necessarily related to the extraction procedure. Certain dental conditions such as gum disease, apical periodontitis, and pulpitis affecting nearby teeth can cause pain to spread throughout the jaw, including the extraction site.

In other, less common situations, a nerve may be injured during the procedure, resulting in a long-term tingling or burning sensation.

Understanding the Underlying Mechanisms of Mouth Pain

jaw innervation

Mouth pain is a common response to things like inflammation, injuries, or aggression. It happens when certain nerve endings, called nociceptors, get triggered in our tissues. Causes can include tooth decay, gum disease, trauma or infection.

In addition to nociception, mouth pain can result from neurogenic and psychogenic mechanisms, where pain may manifest without an apparent injury. Instead, they are due to issues with the nervous system or psychological disorders like depression and anxiety.

Among the possible causes of the pain that appears several years after a wisdom tooth extraction:

1. Dental cavities or fractures in neighboring teeth

tooth layers
Cavities affect the hard tissues of the teeth, including the enamel, which is the outermost layer of the tooth, and the underlying dentin. If left untreated, cavities will continue to progress toward the pulp where the nerves and blood vessels of the tooth are located.

Once bacteria infiltrate the pulp, they multiply, triggering an infection and causing a condition known as pulpitis. Pulpitis can trigger a severe toothache, disrupting sleep with its sharp and intense pain.

The discomfort may extend to nearby teeth, jaws, temporomandibular joints, and even the ear, making it sometimes difficult to identify exactly where it's coming from.

Hence, a remote infection within your mouth has the potential to spread to various sites, including healthy areas. It is crucial to rule out this possibility before looking further.

2. Gum disease

advanced stage of gum disease
Gum disease encompasses gingivitis and periodontitis, which are inflammatory conditions caused by the accumulation of bacteria.

When plaque accumulates along the gumline, it causes bacteria to proliferate and damage the tissues that surround the tooth.

Teeth at the back of the mouth are particularly vulnerable, as these are harder to reach and clean with the toothbrush. So plaque is more likely to build up there.

As a result, the gums and bone that hold the teeth will gradually pull away, causing sensitivity and tooth loss.

Symptoms of gum disease include:

  • Redness and swelling of the gums.
  • Bleeding when you eat or brush your teeth.
  • Gum and tooth sensitivity.
  • Gum recession and tooth loosening.
  • Pus discharge around the teeth.
  • Bad breath.
  • Teeth shifting leading to an improper bite.

To effectively treat gum disease, it is important to address the underlying cause. This can be achieved through proper oral hygiene, such as regular brushing and flossing, as well as professional dental cleaning to remove plaque and tartar, the primary culprits of gingivitis and periodontitis. Your dentist may also recommend a mouthwash and an antibiotic to fully eliminate the infection.

3. Something may be stuck in your gum

Sometimes, pain and swelling in your gum can be caused by a foreign body stuck in there. Have you eaten anything crunchy or hard lately, like popcorn or chips? If so, it's possible that a piece got stuck and is causing the discomfort. You may notice your gum swelling and even some pus coming out of it.

4. Muscle and joint pain

jaw muscles and joints pain
Temporomandibular joint disorders (TMDs) are another potential cause of pain. These disorders involve the chewing muscles and joints that connect the lower jaw to the skull.

TMDs can cause pain that extends to the jaws and teeth area. Sometimes, patients feel as if they have a toothache rather than muscle or joint problems.

Symptoms may include:
  • Pain or tenderness in the jaw, face, neck or around the ears.
  • Difficulty opening or closing the mouth.
  • Increased pain when chewing.
  • Teeth grinding.

5. A nerve might be damaged during the procedure

Nerve damage during wisdom tooth removal is uncommon. Even if it occurs, it's typically a temporary issue that resolves on its own within a few weeks or months.

During the extraction procedure, there's a small risk that a nerve may get accidentally injured or, in rare cases, severed.

This complication is more frequent with lower wisdom teeth, as they often lie close to key nerves that provide sensation to various areas of the face and mouth, including the teeth, gums, chin, tongue, and lower cheeks.

Nerve injuries during the procedure may present as long-lasting tingling or numbness (paresthesia), pain and burning sensation (allodynia), or complete loss of sensation (anesthesia).

In most cases, these sensory disturbances resolve within the initial 6 months post-procedure. However, if symptoms persist or show no improvement after 24 months, the deficit will be considered permanent.

6. Residual cyst of the jaws

Oral cysts are a common condition that can affect bones or soft tissues. They are fluid-filled cavities that grow slowly and silently for years without causing pain.

cyst on the jaw after tooth extraction

Most oral cysts are tooth-related and occur inside the jawbone. One of them is called the residual cyst, which represents 5%.

The residual cyst occurs after a tooth has been removed and evolves slowly without any symptoms. You may feel pain or discomfort only if it becomes large or infected (after years to decades). In this case, the gum becomes red and swollen, associated with a flow of pus.

Sometimes, as the cyst grows, you may feel pressure in your jaw and indefinable discomfort in the neighboring teeth.

7. Atypical odontalgia

Atypical odontalgia or phantom tooth pain is relatively uncommon, affecting 0.03% to 1% of the population, primarily women after 40 years of age.

Atypical odontalgia is defined as persistent pain in one or more teeth or extraction sites in the absence of any visible injury or identifiable cause. In 83% of cases, it occurs after an oral procedure such as extraction or root canal. The area affected seems healthy, which can be confusing for you and your dentist.

The pain is described as a burning or throbbing sensation that cannot be relieved by over-the-counter painkillers. However, in most cases, it remains moderate and should not prevent you from sleeping.

The causes are still poorly understood, but many agree on its neurogenic nature. This confusion often leads to unnecessary dental treatments that only aggravate the condition.

Treatment of atypical odontalgia is symptomatic, focusing primarily on pain and discomfort management.


After having a wisdom tooth removed, it is normal to experience some swelling and pain. These should gradually subside within a few weeks.

However, if the pain persists longer than expected, or if it suddenly appears several years after the procedure, it may be a post-operative complication or an underlying dental or facial condition.

Only a professional examination can accurately diagnose the problem and provide the appropriate treatment.

  1. Advances in understanding nociception and neuropathic pain https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5808094/
  2. Residual cyst of the jaws: A clinico-pathologic study of this seemingly inconspicuous lesion https://pubmed.ncbi.nlm.nih.gov/33332452/
  3. Atypical odontalgia – pathophysiology and clinical management https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2842.2007.01813.x